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HALLUX VALGUS AND HAMMER TOE.
1028 in but slight degree to that poured out during health; (2) that there was no indication that this secretion was associated either with hyperacidity or hyperchlorhydria; and (3) that apart from the presence of blood there was nothing in the fluid indicative of a true lesion of the stomach. It has sometimes been suggested in cases like this, where there was abundant vomiting of blood, that we might be dealing with an ulcer of the stomach-an ulcer of the same type and significance as the perforating ulcer of the foot. But it seems to me that, in this case at least, such a hypothesis is untenable and in other reported cases it appears equally wanting in proof. It could hardly be expected that an ulcer which bled freely every two or three weeks would not leave some trace of its presence in the shape of disordered digestion, pain, or other symptom between the attacks. But it has been pointed out that this patient enjoyed excellent gastric health between the crises, exhibiting no trace of stomach lesion on careful physical examination, and digesting so rapidly and perfectly that it was not possible to find any trace of a test dinner two and a half hours after its ingestion, It is quite possible that in such cases the source of the bleeding lies in engorged or varicose veins around the cardiac end of the oesophagus.
Glasgow.
Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL,
AND
THERAPEUTICAL. HALLUX VALGUS AND HAMMER TOE.
BY W. J. COLLINS, B.SC., M.S., M.D. LOND., F.R.C.S.ENG., SURGEON TO THE LONDON TEMPERANCE HOSPITAL AND TO THE ROYAL EYE HOSPITAL ; FELLOW OF THE UNIVERSITY OF LONDON.
should be almost the exclusive prerogative of the hallux. The support afforded by the other toes might have been thought to operate in the direction of resisting such deviation. But, as in the case illustrated above, it will be seen that so strong was the valgus impulse that the coincident deformity of a hammer second toe afforded ’ no obstacle. Similarly it is the second digit which most frequently, though not exclusively, exhibits the "hammer" deformity. Doubtless the free mobility of the metatarsophalangeal and inter-phalangeal joints, partaking of the nature of a universal and not only of a ginglymus movement, readily lends itself to extrinsic pressure. Any deviation from the normal line once started would tend to be stereotyped by intrinsic assistance. Thus the insertion of the innermost tendon of the extensor brevis digitorum into the base of the first phalanx of the big toe and the diagonal direction of its pull would cooperate in a valgus deviation. Similarly the second toe alone has inserted into the base of its first phalanx the tendons of two dorsal interosseous muscles. Here the malleus deformity once started would be assisted by muscular action and ligamentous shortenings would tend to perpetuate and to fix a dislocation in the first instance intermittent and reducible. The good result of aseptic excision of the heads of the proximal bones without division of any tendons is well shown by Figs. 1 and 2 reproduced from photographs taken before and after operation. The case was one of combined hallux valgus and hammer toe in a woman, aged 36 years. I operated on March 9th of this year, on the 18th the splints were left off, and on the 23rd the patient was discharged, walking well without pain and the toes in perfect position and naturally mobile. Albert-terrace, N.W.
NOTES ON SOME CASES ILLUSTRATING THE ADVANTAGES OF PARTIAL CHLOROFORM ANÆSTHESIA. BY LIEUTENANT-COLONEL E. LAWRIE, M.B. EDIN., I.M.S., RESIDENCY SURGEON, HYDERABAD, DECCAN.
AMONG the minor deformities the pathology of which is obscure and the treatment of which has varied from CASE 1.—The patient was a male native, aged 31 years. elaborate trifling to unduly mutilative heroism is hallux The operation took place on Jan. 14th, 1899. Food had last valgus with the closely allied hammer toe. Congenital been taken at 7 P.M. on the previous day. The operation causation, ligamentous contracture, tendinous abbreviation, was the of an of the liver. Mr. Salar abscess aspiration and external pressure have each and all been invoked to was the chloroformist. The a Musood, third-year student, in one drachm doses atadministration commenced FIG. 2. FIG. 1.
The total duration of the operation was four minutes and seconds and the amount of chloroform employed was two drachms. CASE 2.-The patient, a male native, aged 45 years, had last taken food at 6 A.M. on the day of the operation (Jan. 14th, 1899). This operation also was the aspiration of an abscess of the liver and the chloroformist was Mr. Salar Musood. The administration commenced atseven
Hallux
valgus and hammer toe. Before operation.
After resection of
joints.
this inartistic and most discomforting deformity. Treatment has. of course, varied according to the view entertained as to the general or particular cause, and even recent works recommend amputation in despair of securing success by any less radical procedure. It is curious that the "valgus" tendency in the toes
explain
The operation lasted for three minutes and 53 seconds. The amount of chloroform employed was two drachms. CASE 3.-A male native, aged 25 years, who had last taken food at 8 A.M. was operated upon on Jan. 14th, 1899, the operation being, as in the two former cases, one of aspiration of an abscess of the liver. Mr. Salar Musood
Glasgow.
Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL,
AND
THERAPEUTICAL. HALLUX VALGUS AND HAMMER TOE.
BY W. J. COLLINS, B.SC., M.S., M.D. LOND., F.R.C.S.ENG., SURGEON TO THE LONDON TEMPERANCE HOSPITAL AND TO THE ROYAL EYE HOSPITAL ; FELLOW OF THE UNIVERSITY OF LONDON.
should be almost the exclusive prerogative of the hallux. The support afforded by the other toes might have been thought to operate in the direction of resisting such deviation. But, as in the case illustrated above, it will be seen that so strong was the valgus impulse that the coincident deformity of a hammer second toe afforded ’ no obstacle. Similarly it is the second digit which most frequently, though not exclusively, exhibits the "hammer" deformity. Doubtless the free mobility of the metatarsophalangeal and inter-phalangeal joints, partaking of the nature of a universal and not only of a ginglymus movement, readily lends itself to extrinsic pressure. Any deviation from the normal line once started would tend to be stereotyped by intrinsic assistance. Thus the insertion of the innermost tendon of the extensor brevis digitorum into the base of the first phalanx of the big toe and the diagonal direction of its pull would cooperate in a valgus deviation. Similarly the second toe alone has inserted into the base of its first phalanx the tendons of two dorsal interosseous muscles. Here the malleus deformity once started would be assisted by muscular action and ligamentous shortenings would tend to perpetuate and to fix a dislocation in the first instance intermittent and reducible. The good result of aseptic excision of the heads of the proximal bones without division of any tendons is well shown by Figs. 1 and 2 reproduced from photographs taken before and after operation. The case was one of combined hallux valgus and hammer toe in a woman, aged 36 years. I operated on March 9th of this year, on the 18th the splints were left off, and on the 23rd the patient was discharged, walking well without pain and the toes in perfect position and naturally mobile. Albert-terrace, N.W.
NOTES ON SOME CASES ILLUSTRATING THE ADVANTAGES OF PARTIAL CHLOROFORM ANÆSTHESIA. BY LIEUTENANT-COLONEL E. LAWRIE, M.B. EDIN., I.M.S., RESIDENCY SURGEON, HYDERABAD, DECCAN.
AMONG the minor deformities the pathology of which is obscure and the treatment of which has varied from CASE 1.—The patient was a male native, aged 31 years. elaborate trifling to unduly mutilative heroism is hallux The operation took place on Jan. 14th, 1899. Food had last valgus with the closely allied hammer toe. Congenital been taken at 7 P.M. on the previous day. The operation causation, ligamentous contracture, tendinous abbreviation, was the of an of the liver. Mr. Salar abscess aspiration and external pressure have each and all been invoked to was the chloroformist. The a Musood, third-year student, in one drachm doses atadministration commenced FIG. 2. FIG. 1.
The total duration of the operation was four minutes and seconds and the amount of chloroform employed was two drachms. CASE 2.-The patient, a male native, aged 45 years, had last taken food at 6 A.M. on the day of the operation (Jan. 14th, 1899). This operation also was the aspiration of an abscess of the liver and the chloroformist was Mr. Salar Musood. The administration commenced atseven
Hallux
valgus and hammer toe. Before operation.
After resection of
joints.
this inartistic and most discomforting deformity. Treatment has. of course, varied according to the view entertained as to the general or particular cause, and even recent works recommend amputation in despair of securing success by any less radical procedure. It is curious that the "valgus" tendency in the toes
explain
The operation lasted for three minutes and 53 seconds. The amount of chloroform employed was two drachms. CASE 3.-A male native, aged 25 years, who had last taken food at 8 A.M. was operated upon on Jan. 14th, 1899, the operation being, as in the two former cases, one of aspiration of an abscess of the liver. Mr. Salar Musood